tbuckley/cabot-search huggingface dataset:
Abstract 11218: The Variation of Left Heart Size Based on Donor and Recipient Sex and Its Impact on Outcomes After Orthotopic Heart Transplant
Authors: Elie Kozaily, Edward El Am, S. Hammad Jafri, Alexandra M Trevino, Emily L Cummings, Rody G Bou Chaaya, Mohamad Sabra, Parth Savsani, Jack Tiahnybik, Maya Guglin
Journal: Circulation (2022)

Introduction: The impact of sex mismatch on outcomes after orthotopic heart transplant (OHT) remains unclear. We aimed to evaluate the change in left ventricle (LV) size based on donor and recipient sex and examine its association with the outcomes. Methods: This was a single institution, retrospective study among OHT recipients between Jan 2015 and Sept 2020. Patients were excluded if they were&lt;18 years old, received OHT for congenital heart disease, had follow-up&lt;6 months or missing donor variables. We collected donor (D) and recipient (R) clinical and echocardiographic characteristics. First and last echo post OHT were collected at least 2 months apart. Donor data was extracted from UNOS database. Primary outcome was the variation in donor heart size based on sex at first and last echo after transplant and the difference in survival or HF hospitalization. Statistical analysis (T test) was performed using Stata 15.1. Results: Among 156 reviewed patients, N=68 were included. Female (F) recipients (R) median age was 51±16 y, 25% were African-American (AA) while male (M) recipients median age was 56±12y and 19% were AA. Pre-transplant, MR had a higher RV and LV predicted heart mass and higher CO, CI by Fick. Aside from a higher prevalence of hypertension in MR, there was no difference in baseline characteristics. OHT allocation was MD/MR (66%); FD/FR (18%); FD/MR (4%); MD/FR (12%). LVEDD was bigger in MR on the first echo and remained on last echo post-transplant. There was no difference in degree of variation of LV parameters (LVEDD, LVESD, LV thickness) in MD/MR vs FD/MR and FD/FR vs MD/FR. Compared to sex matched, sex mismatched cohort had a non-significant trend towards a bigger degree of variation in LV size at first (-9% ± 10% vs -2% ± 21%;p=0.14) and last echo (-8% ± 12% vs -4% ± 14%;p=0.1).There were 18% (66% acute cellular rejection) cases of rejection split in half between sex matched and mismatched cohort. At a follow-up duration up to 6 years, 25% (N=17/68) of patients did not survive. There was no difference in survival or HF hospitalization in MR vs FR, in sex matched vs sex-mismatched. Conclusions: This is one of the first studies to examine the change in LV size and its impact on outcomes post OHT. The potential impact of LV behavior in M vs F is worth exploring on larger cohorts.
Abstract 12727: Ultrafiltration for Decompensated Heart Failure Using Aquadex® Without Heparin
Authors: Kristina Leonard, Ritika Gupta, Paul Patalinghug, Kyrah Berthiaume, Hayley Mitchel, Sarah Matushinec, Radha Gopalan
Journal: Circulation (2022)

Introduction: Anticoagulation therapy is necessary during ultrafiltration (UF) to prevent thrombus formation during the filtering process. Heparin is the anticoagulating agent recommended by Aquadex®. However, many patients are already within a therapeutic INR range due to warfarin anticoagulation. Here we present a unique case of Aquadex® UF without the use of heparin anticoagulation. Case Presentation: An 87-year-old male with a history of LVAD implant experienced 2 weeks of weight gain and dyspnea on exertion and at rest due to fluid retention despite GDMT and escalation of oral diuretics. On admission, physical exam revealed elevated JVP, ascites, and 3+ bilateral lower extremity pitting edema and 32 pounds weight gain. He was on a home dose of warfarin per LVAD protocol. Investigations revealed INR 2.9, HCT 29.6, BUN 58, and Cr 2.05. Aquadex® UF was initiated with a therapeutic INR range of 2-3. The patient tolerated UF well without complication and was transitioned back to oral diuretics after 4 days of UF, 24 pounds of weight loss, and 7 liters of fluid removal. He was stable at discharge, but was readmitted two weeks later with identical symptoms and INR 1.9, HCT 26, BUN 32, and Cr 1.69. Aquadex® UF was again initiated with a therapeutic INR range 1.5-2. He again tolerated UF well without complication for 4 days, lost 28 pounds, and had 8.9 liters of fluid removed on this second admission. Aquadex® fluid removal during both hospitalizations is depicted in Figure 1. Conclusions: Our case supports the utilization of UF without the use of heparinization on patients who are already anticoagulated with warfarin. Further, successful UF without clotting complications is possible in INR ranges between 1.5-2 and 2-3 as evidenced during the two hospitalizations. Figure 1. INR levels were maintained within therapeutic ranges using warfarin anticoagulation during Aquadex® UF.
Abstract 120: Impact Of Mask Application On Aerosol Generation During Chest Compression And Defibrillation In A Swine Cardiac Arrest Model
Authors: Cindy H Hsu, Robert Middleton, Brendan M McCracken, Nicholas Greer, Traci Cramer, André L Boehman, Mohamad H Tiba, Margaret Wooldridge, Robert W Neumar
Journal: Circulation (2022)

Introduction: We previously demonstrated that defibrillation followed by chest compression generates more aerosols than chest compression or no-flow state alone. However, the best strategies to prevent aerosol spread during cardiac arrest (CA) resuscitation remain unknown. We hypothesized that mask applications could reduce aerosol spread during chest compressions and defibrillation in a swine CA model. Methods: To simulate witnessed CA with bystander-initiated CPR, 24 female non-intubated swine (43.8 [2.7] kg) underwent 4 minutes of untreated ventricular fibrillation CA followed by 10 two-minute cycles of mechanical chest compression and defibrillation without ventilation. The animals were randomized to receive no mask, cloth mask, surgical mask, N95 mask, or a sealed nose cone over their snouts during resuscitation (n=5/group except nose cone n=4). The diameter (0.3 - 10 μm) and quantity of particles generated during 45-second intervals of no-flow, chest compression, and after each defibrillation were measured 2 inches anterior to the snout. Results: There were no significant differences between total particles generated during chest compression after defibrillation in unmasked versus masked animals regardless of the mask type, while the nose cone significantly reduced total particles. These findings were consistent across all 10 defibrillations (Fig. 1a) and all particle sizes (Fig. 1b). Furthermore, the minimal pre- and post-defibrillation particles detected outside of the nose cone indicated that the ineffectiveness of masks in preventing aerosol spread during CA resuscitation was likely due to their inadequate fit (Fig. 1c). Conclusion: Mask application did not reduce aerosol spread during defibrillation followed by chest compression in a swine CA model. Our data indicate that mask fit is a critical parameter for reducing aerosol transport and do not support mask application on CA victims during bystander-initiated CPR.
Abstract 11625: To Cool or Not to Cool for Brugada Syndrome
Authors: Tania Ahuja, Nicholas J Kiefer, Alex Caballero, Raymond Pashun
Journal: Circulation (2022)

Brugada syndrome (BrS) is an autosomal dominant genetic disorder, characterized by abnormal findings on the electrocardiogram (ECG) in conjunction with an increased risk of ventricular tachycardia (VT) and sudden cardiac death. Triggers of the ECG pattern and VT in BrS include fevers, drugs, and electrolyte abnormalities. This case reports a unique treatment approach of targeted temperature management (TTM) to treat persistent fevers and VT secondary to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a patient with BrS. We report the case of a 23 year old male with history of BrS with an intracardiac defibrillator (ICD) who presented to the hospital with chest pain and a runny nose. Vital signs upon admission were notable for temperature of 38.2 o C, heart rate of 155 beats/minute and blood pressure of 134/110 mmHG. Laboratory values on admission revealed a normal complete blood count, a normal basic metabolic panel, an elevated c-reactive protein (CRP) of 19.1, and PCR confirmed SARS-CoV-2 infection, with a cycle threshold value of 16.4. ECG revealed a type 2 Brugada pattern. Interrogation of his ICD revealed 28 device shocks on the morning of admission, with each episode beginning with a premature ventricular contraction inciting polymorphic VT. His transthoracic echocardiogram (TTE) discovered a newly reduced ejection fraction of 25% with global hypokinesis. Persistent VT prompted intubation and sedation with propofol. Repeat SARS-CoV-2 inflammatory markers revealed a rising CRP of 244. Therapies included acetaminophen around the clock and remdesivir and dexamethasone to target COVID-19. During the first two days in the cardiac intensive care unit (CICU), fevers persisted with Brugada pattern on ECG. Given the potential for recurrent VT, targeted TTM was initiated using the Arctic Sun external cooling device to maintain normothermia to 37 o C. After 5 days of no VT, fever curve, Brugada pattern, and inflammatory markers improved. TTM was discontinued, COVID-19 therapies were completed, and he was extubated. His cardiac function normalized on repeat TTE and he was discharged home. We report a unique case of TTM use in a patient with BrS with VT secondary to infection with COVID-19, as a way to decrease fevers and prevent further triggering of VT.
Abstract 12485: Amniotic Fluid Level of NTproBNP as a Novel Biomarker of Heart Failure in Neonates and Infants
Authors: Hidetoshi Uchida
Journal: Circulation (2022)

Background and Aim: Recent advances in fetal echocardiography technology and its widespread use have made it possible to evaluate fetal cardiac function and heart failure more accurately, although there is a paucity of clinically useful biomarkers for the diagnosis of heart failure in neonates. N-terminal prohormone of brain natriuretic peptide (NT-proBNP) in blood is one of the established biomarkers for heart failure and is known to be reduced exponentially after birth in children born full-term but not in premature infants. Nearly all (95%) NT-proBNP in the blood is excreted in urine. All amniotic fluid is replaced by fetal urine after the second trimester. The aim of this study was to investigate whether amniotic fluid NT-proBNP could be a potentially useful biomarker to assess severity of heart failure in neonates. Methods: We conducted a retrospective cohort study of 13 neonates, including 1 congenital heart disease patient not affected by chromosomal anomalies. We collected peripheral blood, umbilical vein blood, and amniotic fluid to assess each correlations: 1) between levels of umbilical vein blood NT-proBNP (uvNT/cre) and serum NT-proBNP (sNT/cre); 2) between levels of NT-proBNP in amniotic fluid(aNT/cre) and umbilical vein blood NT-proBNP (uvNT/cre); 3) between levels of NT-proBNP in amniotic fluid(aNT/cre) and serum NT-proBNP (sNT/cre). Results: Average gestational age for the subjects was 36±2.0 weeks and average birth weight were 2321.9±557.3g. 2 patients need treatment for heart failure. Our data revealed that there were very strong correlations between uvNT/cre and sNT/cre (R=0.970, p&lt;0.05) as well as between aNT/cre and uvNT (R=0.712, p&lt;0.05), between aNT/cre and sNT (R=0.685, p&lt;0.05) respectively, in neonates. Conclusion: Our data demonstrated that aNT/cre could be a useful biomarker for diagnosing heart failure in neonates/fetuses after the third trimester.
Abstract 11337: Impact of Covid-19 Pandemic and Telemedicine on Cardiac Rehabilitation Compliance
Authors: Shanshan Gustafson, Natalie Eichner, Sudip Saha, Natalia Berry
Journal: Circulation (2022)

Introduction: The COVID-19 pandemic changed healthcare access and delivery. This study aims to evaluate the effect of the COVID-19 pandemic on cardiac rehabilitation compliance. Methods: A total of 1888 patients enrolled in Kaiser Permanente Mid-Atlantic States Cardiac Rehabilitation (CR) Program from 2014 to 2022 were included. Demographic data including sex, age, smoking status, weight, HbA1c, and entry diagnosis were evaluated retrospectively from patient charts. Compliance was defined as &gt;/=75% attendance of a total of 12 virtual sessions. Baseline characteristics and compliance were compared between patients who enrolled prior to (N=1496) and after (N=392) the start of the COVID-19 pandemic in March 2020. Data was analyzed using Chi-squared and t-test models. Significance was defined as p&lt;0.05. Results: A significant increase in CR compliance was observed after the start of the pandemic (74% vs 56%, p&lt;0.001). The compliant patients in the pandemic group were younger, had better glycemic control, and less tobacco use (all p &lt; 0.05). They were also more likely to have multiple cardiovascular diagnoses on enrollment of the program. Sex and starting BMI did not significantly defer between the groups. Conclusion: While the pandemic has limited access to care in some areas, we report an increase in virtual CR compliance since the start of the pandemic, particularly among younger patients with better risk factor control. Increased virtual visit options may partly account for this increase, and future work should focus on how to increase accessibility to virtual care for patients of all ages across the spectrum of cardiovascular risk.
Abstract 11723: Defects in the Branch-Chain Amino Acid Pathway is Associated With Doxorubicin-Induced Cardiotoxicity and Preventable With a BCKDK Inhibitor or Metformin
Authors: Jessica Castrillon, Yin Huang, Yuan Hou, Yadi Zhou, Jonathan D Smith, Mina K Chung, Feixiong Cheng
Journal: Circulation (2022)

Background: High exposure to doxorubicin (DOX) chemotherapy is associated with an 18-49% incidence of heart failure in cancer patients. However, the mechanism of cardiotoxicity remains elusive. Emerging evidence suggests that branched-chain amino acid (BCAA) catabolic defect is also a major metabolic hallmark in diseased hearts. However, to our knowledge, the role of cardiac BCAA in developing cardiotoxicity following chemotherapy is unknown. Hypothesis: We posit that dysfunction of branch chain amino acid catabolic flux is associated with doxorubicin-induced cardiotoxicity, and pharmacologic restoration of BCAA catabolic flux will restore cardiomyocyte function. Results: We generated a rat model of doxorubicin-induced heart failure. Using targeted metabolomic profiling, we observed branch chain amino acids (BCAA) are highly correlated with elevated levels of BNP and low ejection fraction. We have utilized human-induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) to study the mechanism of DOX-induced toxicity. Our findings suggest that DOX significantly decreases mitochondrial activity. Specifically, we observed reduced activity of the mitochondrial enzyme BCKDH, a key regulator of BCAA flux. BCAA catabolism is restored following metformin treatment. Furthermore, we observe the inhibition of BCKDK with the allosteric inhibitor, BT2 (3,6-dichlorobenzo[b]thiophene-2 carboxylic acid), or metformin rescues cell toxicity. Conclusion: We have provided compelling evidence for targeting the BCAA pathway as a strategy for preventing cardiotoxicity. Further work is required to evaluate transcriptional changes driving DOX-mediated toxicity.
Abstract 11465: Impact of a QTc Risk Score Advisory on Mortality in Intensive Care Units
Authors: Daniel Malone, C. Heise, Malinda S Tan, Tyler Gallo, James E Tisdale, Raymond Woosley, Corneliu Antonescu, Sheila Gephart
Journal: Circulation (2022)

Introduction: Prolongation of the heart rate-corrected QT interval (QTc) is associated with increased mortality. We hypothesized that incorporation of a QTc prolongation risk score (QTc-RS) into a clinical decision support (CDS) advisory may reduce mortality in patients in intensive care units (ICUs). Objective: To evaluate the effectiveness of a QTc-RS risk score CDS on inpatient mortality in ICUs within hospitals in a wide geographical area. Methods: A QTc-RS CDS advisory incorporating a validated risk score using patient information available in the electronic health record was implemented throughout urban and rural facilities in the Banner Health system. Risk factors were assigned points as follows: female (1 point), age &gt; 67 years (1), administration of a loop diuretic (1), diagnosis of acute myocardial infarction (2), serum K + ≤ 3.5 mEq/L (2), sepsis (3), diagnosis of heart failure (3), one medication with a known risk of torsades de pointes (TdP) (3), two or more medications with known risk of TdP (3), and a Fridericia-corrected QTc &gt; 500 ms (4). The QTc-RS was automatically calculated in the background each time an order for medication with a known risk of TdP was initiated. The pre-implementation period consisted of hospitalized patients from January 1, 2020 to March 31, 2020, with QTc-RS ≥12. However, clinicians did not receive a QTc-RS CDS advisory when placing an order for a medication with a known risk of TdP for these patients. The post-implementation period was from April 1, 2020 to December 13, 2020 and included patients where clinicians received an advisory when placing an order for a medication with a known risk of TdP and the QTc-RS ≥12. Logistic regression was conducted to assess the impact of implementing the QTc-RS advisory on inpatient mortality. Results: We evaluated 620 unique hospitalized patients during the pre-implementation period and 3,112 hospitalized patients post-implementation of the CDS. Mortality was lower in the post-implementation cohort compared to that in the pre-implementation cohort (odds ratio =0.61, 95% confidence interval 0.49-0.76). Increasing QTc-RS was associated with increasing mortality [(OR=1.08 (1.02-1.14)]. Conclusion: Implementation of a QTc-RS CDS advisory was associated with lower mortality.
Abstract 12382: The Significance of Cardiac Resynchronization Therapy in Eligible Patients Undergoing Transcatheter Edge-to-Edge Repair for Functional Mitral Regurgitation
Authors: Sharon Natanzon, Alon Shechter, Robert J Siegel, Danon Kaewkes, Keita Koseki, Aum Solanki, Ofir Koren, Brandon Schwartz, Vivek Patel, Tarun Chakravarty, Sabah Skaf, Moody Makar, Jasminka Stegic, Raj Makkar
Journal: Circulation (2022)

Introduction: Current guidelines prioritize the utilization of cardiac resynchronization therapy (CRT) over transcatheter edge-to-edge repair (TEER) in eligible patients with functional mitral regurgitation (FMR). However, the data in support of this recommendation are limited. Objective: To examine the effect of performing TEER for FMR in patients without prior CRT. Methods: This is a single-center, retrospective analysis encompassing 440 days (IQR, 135-915 days) of follow-up after TEER for FMR in patients who fulfilled guideline criteria for CRT. The study cohort was divided according to CRT status prior to the procedure. The primary outcome was the composite of all-cause mortality and heart failure hospitalization at one year. Secondary outcomes included components of the primary outcome, as well as 1-year all-cause hospitalization, and 1-month MR severity, indexed left atrial volume, and indexed left ventricular mass. Results: A total of 126 patients were included in the analysis, of whom 70 (56%) did not have CRT at the time of TEER. Baseline characteristics and immediate procedural success were mostly comparable between those with and those without CRT. The no-CRT group experienced higher rates of the primary outcome (43% vs 25%, p=0.041), which were accounted for by increased mortality (26% vs 11%, p=0.033). After multivariate analysis, the absence of CRT was associated with more than twice the risk of the primary outcome (HR 2.36, 95% CI 1.1-4.98, p=0.024). Secondary endpoints did not differ between the groups. Conclusions: In CRT eligible patients undergoing mitral TEER for FMR, 1-year outcome is less favorable when the procedure is not preceded by CRT.
Abstract 11368: Weight Gain in Young Adults During the Covid-19 Pandemic
Authors: Jesse Goitia, Rohith Nayak, Aiyu Chen, Mingsum S Lee
Journal: Circulation (2022)

Introduction: During the COVID-19 pandemic, measures taken to prevent the spread of the coronavirus have led to significant changes in the lifestyle and habits of young people. The pandemic led to poor dietary patterns, reduced physical activities, and increased mental stress, which are all risk factors for weight gain. The goal of this study was to investigate the pattern of weight gain among young adults between age 18-50 years during the pandemic, and to identify factors associated with significant weight gain of 20 pounds of more. Methods: We included young adults between ages 18 to 50 years with at least one documented weight in their electronic health records before the start of the COVID-19 pandemic shelter-in-place orders (3/19/2019 to 3/19/2020) and at least one documented weight after COVID-19 vaccines became available (12/14/2020 to 12/14/2021). Multivariable logistic regression analysis was used to identify factors associated with greater than 20 pounds of weight gain. Odds ratios (OR) and 95% confidence intervals (CI) were calculated. Results: The study cohort included 133,750 young adults aged 18-50 years (median age 43 years. 39.7% men). The cohort is racially and ethnically diverse, with 22.6% self-identified as White, 7.2% Black, 48.1% Hispanic, and 17.3% Asian. During the pandemic, 53866 (40.3%) lost weight or had no weight gain, 50662 (37.9%) gained 0-9 pounds (lbs), 19422 (14.5%) gained 10-19 lbs, and 9800 (7.3%) gained 20 lbs or more. Individuals who gained 20 lbs or more were younger and more likely to reside in low-income neighborhoods. Multivariable logistic regression demonstrated the following factors to be associated with significant weight gain: male sex (OR 1.10, 95% CI 1.05-1.15), Black race (OR 1.14, 95% CI 1.05-1.23), low income (OR 1.16, 95% CI 1.16-1.35), and history of depression (OR 1.64, 95% CI 1.56-1.73). Conclusions: In this cohort of young adults, 59.7% experienced weight gain during the pandemic, with 7.5% gaining 20 lbs or more. Factors associated with significant weight gain included male sex, black race, low income, and a history of depression. Intervention strategies to promote healthy lifestyle may be particularly important for patients with depression, and young adults from low-income neighborhoods.
Abstract 11099: Body Mass Index and Association With Unguided De-Escalation From Ticagrelor to Clopidogrel in the TALOS-AMI Trial
Authors: Seonghyeon Bu, Sungmin Lim, Jaehyuk Jang, Hyo-Suk Ahn, Chan Joon Kim, Jong-Min Lee, Mahn Won Park, Byung-Hee Hwang, Kwan Yong Lee, Eunho Choo, Kiyuk Chang
Journal: Circulation (2022)

Introduction: Potent antiplatelet therapy has a high bleeding risk after acute myocardial infarction, so de-escalation from ticagrelor to clopidogrel has recently been introduced. But, optimal de-escalation strategy according to BMI is unclear. Method In TALOS-AMI trial, patients with acute myocardial infarction receiving aspirin and ticagrelor after index percutaneous coronary intervention (PCI) were investigated. This post hoc study determined the efficacy and safety of de-escalation (clopidogrel plus aspirin) compared with active control (ticagrelor plus aspirin) across a range of patient BMIs. Results Among 2,686 randomized patients, 1,558 (58.0%) had 18.5 ≤BMI &lt;25 kg/m2, 935 (34.8%) had 25 ≤ BMI &lt; 30 kg/m2, and 154 (5.7%) had BMI ≥ 30 kg/m2. The combination of clopidogrel plus aspirin compared with ticagrelor plus aspirin reduced in the primary outcome led by bleeding events reduction, in 18.5 ≤BMI &lt;25 kg/m2. For 18.5 ≤BMI &lt;25 kg/m2: 4.3% vs. 7.9%; hazard ratio (HR): 0.516 (95% confidential interval [CI]: 0.334 to 0.797); 25 ≤ BMI &lt;30 kg/m2: 4.9% vs. 7.1%; HR: 0.674 (95% CI: 0.389 to 1.166); BMI ≥30 kg/m2: 1.2% vs. 4.2%; HR: 0.284 (95% CI: 0.029 to 2.792). Conclusion In conclusion, our results suggest that in the patients of 18.5 kg/m2 ≤BMI &lt;25 kg/m2, with acute myocardial infarction after index PCI, de-escalation strategy is better net clinical outcome, mainly by reducing the bleeding events. But, there are no differences between two groups BMI ≥25 kg/m2.